Healthcare Provider Details

I. General information

NPI: 1063711810
Provider Name (Legal Business Name): RICHIE LIU LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 LENORA ST STE 160
SEATTLE WA
98121-2754
US

IV. Provider business mailing address

3130 FUHRMAN AVE E
SEATTLE WA
98102-3829
US

V. Phone/Fax

Practice location:
  • Phone: 206-397-3457
  • Fax:
Mailing address:
  • Phone: 949-885-6197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60169471
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: